title: Use of second-line therapies for management of massive primary postpartum hemorrhage.
abstract: OBJECTIVE
  To determine rates of use and success of second-line therapies for massive primary postpartum hemorrhage (PPH).
  
  
  METHODS
  A retrospective cohort study was conducted among 91 women who gave birth at Kwong Wah Hospital, Hong Kong, between January 1, 2006, and December 31, 2011. Inclusion criteria were gestational age of at least 24 weeks and massive PPH (defined as blood loss ≥1500 mL within 24 hours after birth). Second-line therapies assessed were uterine compression sutures, uterine artery embolization, and balloon tamponade after failure of uterine massage and uterotonic agents to stop bleeding.
  
  
  RESULTS
  The rate of massive PPH was 2.65 per 1000 births. Second-line therapies were used among 42 women with PPH, equivalent to a rate of 1.23 per 1000 births. Only 21.4% of the women who received second-line therapies required rescue hysterectomy. A rising trend was observed for the use of second-line therapies, whereas the incidence of rescue hysterectomy and estimated blood loss were found to concomitantly decrease.
  
  
  CONCLUSIONS
  Increasing use of second-line therapies among women with massive PPH was associated with a decreasing trend for rescue hysterectomy. Obstetricians should, therefore, consider all available interventions to stop PPH, including early use of second-line options.
authors.affiliation: Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong. cll442@ha.org.hk
authors.forename: Lai-Ling
authors.initials: LL
authors.lastname: Chan
authors.forename: Tsz-Kin
authors.initials: TK
authors.lastname: Lo
authors.forename: Wai-Lam
authors.initials: WL
authors.lastname: Lau
authors.forename: Samuel
authors.initials: S
authors.lastname: Lau
authors.forename: Bassanio
authors.initials: B
authors.lastname: Law
authors.forename: Hin-Hung
authors.initials: HH
authors.lastname: Tsang
authors.forename: Wing-Cheong
authors.initials: WC
authors.lastname: Leung
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006723:Hong Kong; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D008405:Massage / Q000379:methods; D010120:Oxytocics / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D058738:Uterine Balloon Tamponade / Q000379:methods*
chemical_list: D010120:Oxytocics
keywords: Balloon tamponade; Hysterectomy; Primary postpartum hemorrhage; Second-line therapy; Uterine arterial embolization; Uterine compression suture